EXPLANATION: CAPITALS INDICATE MAT TER ADDED TO EXISTIN G LAW.
[Brackets] indicate matter deleted from existing law.
Underlining indicates amendments to bill.
Strike out indicates matter stricken from the bill by amendment or deleted from the law by
amendment.
*sb0637*
SENATE BILL 637
J1, J5 2lr1432
CF HB 935
By: Senator Augustine
Introduced and read first time: February 3, 2022
Assigned to: Finance
Committee Report: Favorable with amendments
Senate action: Adopted
Read second time: March 27, 2022
CHAPTER ______
AN ACT concerning 1
Health and Health Insurance – Behavioral Health Services – Expansion 2
(Behavioral Health System Modernization Act) 3
FOR the purpose of requiring the Maryland Medical Assistance Program to provide 4
reimbursement for certain behavioral health peer recovery, measurement–based 5
care, and crisis response services, subject to certain limitations; requiring the 6
Maryland Department of Health to expand access to and provide reimbursement for 7
certain behavioral health collaborative care, case management, and wraparound 8
services; requiring the Governor to include in the annual budget bill certain 9
appropriations to fund certain behavioral health services and supports; requiring 10
certain insurers, nonprofit health service plans, and health maintenance 11
organizations to provide coverage and reimbursement for certain behavioral health 12
services Maryland Department of Health to review and consider options for adopting 13
existing programs or services to provide wraparound services to children and youth 14
with primary substance use disorders and review and make recommendations 15
regarding eligibility requirements for the 1915(i) waiver and mental health case 16
management; requiring the Maryland Insurance Administration, in consultation 17
with certain stakeholders, to study and make recommendations on certain issues 18
related to commercial carrier reimbursement of behavioral health clinical peer 19
specialists and crisis response services; and generally relating to the expansion of 20
the provision, funding, and coverage of and eligibility for behavioral health services. 21
BY adding to 22
Article – Health – General 23 2 SENATE BILL 637
Section 7.5–901 to be under the new subtitle “Subtitle 9. Funding for Wellness and 1
Recovery Centers, Recovery Community Centers, and Peer Recovery 2
Services”; 15–101(a–1), (a–2), and (e–1) and 15–103(a)(2)(xviii); and 15–1101 3
and 15–1102 to be under the new subtitle “Subtitle 11. Home – and 4
Community–Based Services for Children and Youth” 5
Annotated Code of Maryland 6
(2019 Replacement Volume and 2021 Supplement) 7
BY repealing and reenacting, without amendments, 8
Article – Health – General 9
Section 15–101(a) and 15–103(a)(1) 10
Annotated Code of Maryland 11
(2019 Replacement Volume and 2021 Supplement) 12
BY repealing and reenacting, with amendments, 13
Article – Health – General 14
Section 15–101(a–1) and (a–2), 15–103(a)(2)(xvi) and (xvii), and 15–141.1 15
Annotated Code of Maryland 16
(2019 Replacement Volume and 2021 Supplement) 17
BY adding to 18
Article – Insurance 19
Section 15–717 and 15–857 20
Annotated Code of Maryland 21
(2017 Replacement Volume and 2021 Supplement) 22
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 23
That the Laws of Maryland read as follows: 24
Article – Health – General 25
SUBTITLE 9. FUNDING FOR WELLNESS AND RECOVERY CENTERS, RECOVERY 26
COMMUNITY CENTERS, AND PEER RECOVERY SERVICES. 27
7.5–901. 28
THE GOVERNOR SHALL INCLUD E IN THE ANNUAL BUDG ET BILL THE 29
FOLLOWING AMOUNTS FO R WELLNESS AND RECOV ERY CENTERS, RECOVERY 30
COMMUNITY CENTERS , AND PEER RECOVERY SE RVICES: 31
(1) $15,000,000 FOR FISCAL YEAR 2024; 32
(2) $18,000,000 FOR FISCAL YEAR 2025; 33
(3) $21,000,000 FOR FISCAL YEAR 2026; AND 34
SENATE BILL 637 3
(4) $24,000,000 FOR FISCAL YEAR 2027 AND EACH FISCAL YEAR 1
THEREAFTER . 2
15–101. 3
(a) In this title the following words have the meanings indicated. 4
(A–1) “BEHAVIORAL HEALTH CRI SIS RESPONSE SERVICE S” MEANS 5
EVIDENCE–BASED RESOURCES DESI GNED TO SERVE INDIVI DUALS EXPERIENCING A 6
MENTAL HEALTH OR SUB STANCE USE EMERGENCY , INCLUDING: 7
(1) CRISIS CALL CENTERS A ND HOTLINE SERVICES ; 8
(2) MOBILE CRISIS SERVICE S; AND 9
(3) CRISIS RECEIVING AND STABILIZATION SERVIC ES. 10
(A–2) “CERTIFIED PEER RECOVE RY SPECIALIST” MEANS AN INDIVIDUAL WHO 11
HAS BEEN CERTIFIED B Y AN ENTITY APPROVED BY THE DEPARTMENT FOR THE 12
PURPOSE OF PROVIDING PEER SUPPORT SERVICE S, AS DEFINED UNDER § 7.5–101 13
OF THIS ARTICLE. 14
[(a–1)] (A–3) “Dental managed care organization” means a pre–paid dental 15
plan that receives fees to manage dental services. 16
[(a–2)] (A–4) “Dental services” means diagnostic, emergency, preventive, and 17
therapeutic services for oral diseases. 18
(E–1) “MEASUREMENT –BASED CARE” MEANS AN EVIDENCE –BASED PRACTICE 19
THAT INVOLVES THE SY STEMATIC COLLECTION OF DATA TO MONITOR T REATMENT 20
PROGRESS, ASSESS OUTCOMES , AND GUIDE TREATMENT DECISIONS, FROM INITIAL 21
SCREENING TO COMPLET ION OF CARE, THAT IS USED TO EVAL UATE: 22
(1) SYMPTOMS; 23
(2) FUNCTIONING AND SATIS FACTION WITH LIFE ; 24
(3) READINESS TO CHANGE ; AND 25
(4) THE TREATMENT PROCESS . 26
15–103. 27
(a) (1) The Secretary shall administer the Maryland Medical Assistance 28
Program. 29 4 SENATE BILL 637
(2) The Program: 1
(xvi) Beginning on January 1, 2021, shall provide, subject to the 2
limitations of the State budget and § 15–855(b)(2) of the Insurance Article, and as permitted 3
by federal law, services for pediatric autoimmune neuropsychiatric disorders associated 4
with streptococcal infections and pediatric acute onset neuropsychiatric syndrome, 5
including the use of intravenous immunoglobulin therapy, for eligible Program recipients, 6
if pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections 7
and pediatric acute onset neuropsychiatric syndrome are coded for billing and diagnosis 8
purposes in accordance with § 15–855(d) of the Insurance Article; [and] 9
(xvii) Beginning on January 1, 2022, may not include, subject to federal 10
approval and limitations of the State budget, a frequency limitation on covered dental 11
prophylaxis care or oral health exams that requires the dental prophylaxis care or oral 12
health exams to be provided at an interval greater than 120 days within a plan year; AND 13
(XVIII) BEGINNING ON JANUARY 1, 2023, SHALL PROVIDE , 14
SUBJECT TO THE LIMIT ATIONS OF THE STATE BUDGET , AND AS PERMITTED BY 15
FEDERAL LAW , REIMBURSEMENT FOR : 16
1. SERVICES PROVIDED BY CERTIFIED PEER RECOV ERY 17
SPECIALISTS; 18
2. MEASUREMENT –BASED CARE PROVIDED IN 19
BEHAVIORAL HEALTH SETTIN GS, INCLUDING OUTPATIENT MENTAL HEALTH 20
CENTERS; AND 21
3. BEHAVIORAL HEALTH CRI SIS RESPONSE SERVICE S. 22
15–141.1. 23
(a) [(1)] In this section [the following words have the meanings indicated. 24
(2)], “Collaborative Care Model” means an evidence–based approach for 25
integrating somatic and behavioral health services in primary care settings that includes: 26
[(i)] (1) Care coordination and management; 27
[(ii)] (2) Regular, proactive outcome monitoring and treatment for 28
outcome targets using standardized outcome measurement rating scales and electronic 29
tools, such as patient tracking; and 30
[(iii)] (3) Regular systematic psychiatric and substance use disorder 31
caseload reviews and consultation with a psychiatrist, an addiction medicine specialist, or 32 SENATE BILL 637 5
any other behavioral health medicine specialist as allowed under federal regulations 1
governing the model. 2
[(3) “Pilot Program” means the Collaborative Care Pilot Program.] 3
(b) This section may not be construed to prohibit referrals from a primary care 4
provider to a specialty behavioral health care provider. 5
[(c) There is a Collaborative Care Pilot Program in the Department. 6
(d) The purpose of the Pilot Program is to establish and implement a 7
Collaborative Care Model in primary care settings in which health care services are 8
provided to Program recipients enrolled in HealthChoice. 9
(e) The Department shall administer the Pilot Program. 10
(f) (1) The Department shall select up to three sites at which a Collaborative 11
Care Model shall be established over a 4–year period. 12
(2) The sites selected by the Department shall be adult or pediatric 13
nonspecialty medical practices or health systems that serve a significant number of 14
Program recipients. 15
(3) To the extent practicable, one of the sites selected by the Department 16
under paragraph (1) of this subsection shall be located in a rural area of the State. 17
(g) The sites selected by the Department under subsection (f) of this section shall 18
ensure that treatment services, prescriptions, and care management that would be 19
provided to an individual under the Pilot Program are not duplicative of specialty 20
behavioral health care services being received by the individual. 21
(h) The Department shall provide funding to sites participating in the Pilot 22
Program for: 23
(1) Infrastructure development, including the development of a patient 24
registry and other monitoring, reporting, and billing tools required to implement a 25
Collaborative Care Model; 26
(2) Training staff to implement the Collaborative Care Model; 27
(3) Staffing for care management and psychiatric consultation provided 28
under the Collaborative Care Model; and 29
(4) Other purposes necessary to implement and evaluate the Collaborative 30
Care Model. 31
(i) The Department shall: 32 6 SENATE BILL 637
(1) Collaborate with stakeholders in the development, implementation, 1
and outcome monitoring of the Pilot Program; and 2
(2) Collect outcomes data on recipients of health care services under the 3
Pilot Program to: 4
(i) Evaluate the effectiveness of the Collaborative Care Model, 5
including by evaluating the number of and outcomes for individuals who: 6
1. Were not diagnosed as having a behavioral health 7
condition before receiving treatment through the Pilot Program; 8
2. Were not diagnosed as having a behaviora l health 9
condition before being referred to and treated by a specialty behavioral health provider; 10
3. Received behavioral health services in a primary care 11
setting before receiving treatment through the Pilot Program; and 12
4. Received specialty behavioral health care services before 13
being identified as eligible to receive treatment through the Pilot Program; and] 14
[(ii)] (C) [Determine whether to] THE DEPARTMENT SHALL 15
implement AND PROVIDE REIMBURS EMENT FOR SERVICES P ROVIDED IN 16
ACCORDANCE WITH the Collaborative Care Model statewide in primary care settings that 17
provide health care services to Program recipients. 18
[(j) The Department shall apply to the Centers for Medicare and Medicaid 19
Services for an amendment to the State’s § 1115 HealthChoice Demonstration waiver if 20
necessary to implement the Pilot Program. 21
(k) For fiscal year 2020, fiscal year 2021, fiscal year 2022, and fiscal year 2023, 22
the Governor shall include in the annual budget an appropriation of $550,000 for the Pilot 23
Program. 24
(l) On or before November 1, 2023, the Department shall report to the Governor 25
and, in accordance with § 2–1257 of the State Government Article, the General Assembly 26
on the Department’s findings and recommendations from the Pilot Program.] 27
SUBTITLE 11. HOME– AND COMMUNITY–BASED SERVICES FOR CHILDREN AND 28
YOUTH. 29
15–1101. 30
(A) IN THIS SUBTITLE THE FOLLOWING WORDS HAVE THE MEANINGS 31
INDICATED. 32 SENATE BILL 637 7
(B) “FAMILY–CENTERED TREATMENT ” MEANS AN EVIDENCE –BASED 1
PRACTICE USED TO STA BILIZE YOUTH IN THE HOME BY ADDRESSING UNDERLYING 2
FUNCTIONS OF BEHAVIO R IN ORDER TO REDUCE DISRUPTIONS IN THE H OME, 3
SCHOOL, AND COMMUNITY . 4
(C) “FUNCTIONAL FAMILY THE RAPY” MEANS A FAMILY –BASED 5
PREVENTION AND INTER VENTION PROGRAM FOR HIGH–RISK YOUTH THAT 6
ADDRESSES COMPLEX AN D MULTIDIMENSIONAL P ROBLEMS THROUGH CLIN ICAL 7
PRACTICE THAT IS FLE XIBLY STRUCTURED AND CULTURALLY SENSITIVE . 8
(D) “MENTAL HEALTH CASE MA NAGEMENT PROGRAM ” MEANS A PROGRAM 9
THAT PROVIDES AN IDE NTIFIED SUBSET OF WR APAROUND SERVICES . 10
(E) “1915(I) MODEL” MEANS THE 1915(I) INTENSIVE BEHAVIORAL HEALTH 11
SERVICES FOR CHILDREN, YOUTH, AND FAMILIES PROGRAM ESTA BLISHED UNDER 12
TITLE 10, SUBTITLE 9, CHAPTER 89 OF THE CODE OF MARYLAND REGULATIONS. 13
(F) “WRAPAROUND SERVICES ” MEANS SERVICES PROVI DED TO CHILDREN 14
AND YOUTH WITH INTEN SIVE MENTAL HEALTH NEEDS AND THE IR FAMILIES IN 15
THEIR COMMUNITIES , INCLUDING: 16
(1) INTENSIVE CARE COORDI NATION; 17
(2) CHILD AND FAMILY TEAM MEETINGS; AND 18
(3) PLANS OF CARE THAT AR E INDIVIDUALIZED TO EACH FAMILY AND 19
INCLUDE: 20
(I) FORMAL SUPPORTS , INCLUDING INDIVIDUAL AND FAMIL Y 21
THERAPY; AND 22
(II) INFORMAL SUPPORTS , INCLUDING INTENSIVE IN–HOME 23
SERVICES, RESPITE CARE, MOBILE CRISIS RESPON SE AND STABILIZATION , FAMILY 24
PEER SUPPORT , EXPERIENTIAL THERAPI ES, AND FLEXIBLE FUNDS F OR GOODS AND 25
SERVICES THAT ARE ID ENTIFIED IN THE PLAN OF CARE. 26
15–1102. 27
(A) THE DEPARTMENT SHALL ENSU RE THAT CARE COORDIN ATORS 28
DELIVERING SERVICES UNDER THE 1915(I) MODEL OR A MENTAL HE ALTH CASE 29
MANAGEMENT PROGRAM R ECEIVE TRAINING IN T HE DELIVERY OF WRAPA ROUND 30
SERVICES. 31
8 SENATE BILL 637
(B) THE DEPARTMENT SHALL PROVIDE R EIMBURSEMENT FOR : 1
(1) WRAPAROUND SERVICES D ELIVERED BY CARE COO RDINATORS 2
UNDER THE 1915(I) MODEL OR A MENTAL HE ALTH CASE MANAGEMENT PROGRAM 3
THAT IS COMMENSURATE WITH INDUSTRY STANDA RDS FOR THE REIMBURS EMENT 4
OF THE DELIVERY OF W RAPAROUND SERVICES; AND 5
(2) INTENSIVE IN–HOME SERVICES DELIVE RED BY PROVIDERS USI NG 6
FAMILY–CENTERED TREATMENT , FUNCTIONAL FAMILY TH ERAPY, AND OTHER 7
EVIDENCE–BASED PRACTICES UNDE R THE 1915(I) MODEL THAT IS COMMEN SURATE 8
WITH INDUSTRY STANDA RDS FOR THE REIMBURSEMENT OF THE DELIVERY OF 9
FAMILY–CENTERED TREATMENT , FUNCTIONAL FAMILY TH ERAPY, AND OTHER 10
EVIDENCE–BASED PRACTICES . 11
(C) BEGINNING IN FISCAL Y EAR 2023, THE BEHAVIORAL HEALTH 12
ADMINISTRATION SHALL FUND 100 SLOTS IN THE MENTAL HEALTH CASE 13
MANAGEMENT P ROGRAM FOR CHILDREN OR YOUTH WHO ARE NOT ELIGIBLE FOR 14
PROGRAM SERVICES AND AT RISK OF OUT–OF–HOME PLACEMENT . 15
(D) THE GOVERNOR SHALL INCLUD E IN THE ANNUAL OPER ATING BUDGET 16
BILL THE FOLLOWING A MOUNTS TO FUND CUSTO MIZED GOODS AND SERV ICES FOR 17
YOUTH RECEIVIN G SERVICES UNDER THE 1915(I) MODEL OR MENTAL HEAL TH CASE 18
MANAGEMENT PROGRAM : 19
(1) $150,000 FOR FISCAL YEAR 2024; 20
(2) $250,000 FOR FISCAL YEAR 2025; AND 21
(3) $350,000 FOR FISCAL YEAR 2026 AND EACH FISCAL YEAR 22
THEREAFTER . 23
Article – Insurance 24
15–717. 25
(A) IN THIS SECTION, “CERTIFIED PEER RECOV ERY SPECIALIST” MEANS AN 26
INDIVIDUAL WHO HAS B EEN CERTIFIED BY AN ENTITY APPROVED BY T HE 27
MARYLAND DEPARTMENT OF HEALTH FOR THE PURPOS E OF PROVIDING PEER 28
SUPPORT SERVICES , AS DEFINED UNDER § 7.5–101 OF THE HEALTH – GENERAL 29
ARTICLE. 30
(B) THIS SECTION APPLIES TO: 31
SENATE BILL 637 9
(1) INSURERS AND NONPROF IT HEALTH SERVICE PL ANS THAT 1
PROVIDE HOSPITAL , MEDICAL, OR SURGICAL BENEFITS TO INDIVIDUALS OR GR OUPS 2
ON AN EXPENSE –INCURRED BASIS UNDER HEALTH INSURANCE POL ICIES OR 3
CONTRACTS THA T ARE ISSUED OR DELI VERED IN THE STATE; AND 4
(2) HEALTH MAINTENANCE O RGANIZATIONS THAT PR OVIDE 5
HOSPITAL, MEDICAL, OR SURGICAL BENEFITS TO INDIVIDUALS OR GR OUPS UNDER 6
CONTRACTS THAT ARE I SSUED OR DELIVERED I N THE STATE. 7
(C) IF A POLICY OR CONTRA CT SUBJECT TO THIS SECTION P ROVIDES FOR 8
REIMBURSEMENT FOR A SERVICE THAT IS WITH IN THE LAWFUL SCOPE OF 9
ACTIVITIES OF A CERT IFIED PEER RECOVERY SPECIALIST PROVIDING SERVICES 10
UNDER THE SUPERVISIO N OF A BEHAVIORAL HE ALTH PROGRAM LICENSE D BY THE 11
SECRETARY OF HEALTH UNDER § 7.5–401 OF THE HEALTH – GENERAL ARTICLE, 12
THE INSURED OR ANY O THER PERSON COVERED BY THE POLICY OR CON TRACT IS 13
ENTITLED TO REIMBURS EMENT FOR THE SERVIC E. 14
15–857. 15
(A) (1) IN THIS SECTION THE F OLLOWING WORDS HAVE THE MEANINGS 16
INDICATED. 17
(2) “BEHAVIORAL HEALTH CRISI S RESPONSE SERVICES ” MEANS 18
EVIDENCE–BASED SERVICES DESIG NED TO SERVE INDIVID UALS EXPERIENCING A 19
MENTAL HEALTH OR SUB STANCE USE EMERGENCY , INCLUDING: 20
(I) CRISIS CALL CENTERS AND HOTLINE SERVICES ; 21
(II) MOBILE CRISIS SERVIC ES; AND 22
(III) CRISIS RECEIVING AND STABILIZATION SERVIC ES. 23
(3) “MEASUREMENT –BASED CARE ” MEANS AN EVIDENCE –BASED 24
PRACTICE THAT INVOLV ES THE SYSTEMATIC CO LLECTION OF DATA TO MONITOR 25
TREATMENT PROGRESS , ASSESS OUTCOMES , AND GUIDE TREATMENT DECISIONS, 26
FROM INITIAL SCREENING TO COM PLETION OF CARE , THAT IS USED TO EVAL UATE: 27
(I) SYMPTOMS; 28
(II) FUNCTIONING AND SATI SFACTION WITH LIFE ; 29
(III) READINESS TO CHANGE ; AND 30
(IV) THE TREATMENT PROCES S. 31 10 SENATE BILL 637
(B) THIS SECTION APPLIES TO: 1
(1) INSURERS AND NONPROFIT HEALTH SER VICE PLANS THAT ISSU E 2
OR DELIVER HEALTH IN SURANCE POLICIES OR CONTRACTS IN THE STATE; AND 3
(2) HEALTH MAINTENANCE O RGANIZATIONS THAT PR OVIDE 4
COVERAGE TO INDIVIDU ALS OR GROUPS UNDER CONTRACTS THAT ARE I SSUED OR 5
DELIVERED IN THE STATE. 6
(C) AN ENTITY SUBJECT TO THIS SECTION SHALL P ROVIDE COVERAGE FOR : 7
(1) BEHAVIORAL HEALTH CR ISIS RESPONSE SERVIC ES; AND 8
(2) MEASUREMENT –BASED CARE PROVIDED IN A BEHAVIORAL 9
HEALTH SETTING . 10
SECTION 2. AND BE IT FURTHER ENACTED, That: 11
(a) (1) On or before December 1, 2022, the Maryland Department of Health 12
shall obtain any federal authority necessary to implement a plan for the expansion of 13
certified community behavioral health clinics in the State, including applying to the 14
Centers for Medicare and Medicaid Services for an amendment to any of the State’s 1115 15
waivers or the State plan. 16
(2) The Department’s implementation plan shall ensure access to certified 17
community behavioral health clinics in all counties in the State. 18
(b) (a) The Maryland Department of Health shall review and consider options for 19
expanding the services provided under § 15–1102 of the Health – General Article, as 20
enacted by Section 1 of this Act, or adopting other existing programs or services to provide 21
wraparound services to children and youth with primary substance use disorders. 22
(c) (b) On or before December 1, 2023, the Maryland Department of Health shall 23
review current eligibility requirements for the model established under § 1915(i) of the 24
Social Security Act, and mental health case management generally, and submit 25
recommendations for expanding eligibility and enrollment in these programs to the General 26
Assembly, in accordance with § 2–1257 of the State Government Article. 27
SECTION 3. AND BE IT FURTHER ENACTED, That this Act shall apply to all 28
policies, contracts, and health benefit plans issued, delivered, or renewed in the State on or 29
after January 1, 2023. 30
SECTION 2. AND BE IT FURTHER ENACTED, That: 31
SENATE BILL 637 11
(a) The Maryland Insurance Administration, in consultation with carriers, 1
behavioral health providers, advocates, and other stakeholders, shall conduct a study on 2
operational issues related to commercial carrier reimbursement of behavioral health 3
clinical peer specialists and crisis response services and make recommendations for how to 4
address these issues. 5
(b) On or before November 15, 2022, the Maryland Insurance Administration 6
shall report the findings and recommendations of the study required under subsection (a) 7
of this section to the General Assembly, in accordance with § 2–1257 of the State 8
Government Article. 9
SECTION 4. 3. AND BE IT FURTHER ENACTED, That this Act shall take effect 10
October June 1, 2022. 11
Approved:
________________________________________________________________________________
Governor.
________________________________________________________________________________
President of the Senate.
________________________________________________________________________________
Speaker of the House of Delegates.